Suppose a Healthcare Benefits Service Provider “ACME Software” is seeking to streamline the maintenance and execution of the electronic carrier feed process of HIPAA 834 files as part of its insurance benefits solution.

The proposed solution is a high-level draft that walks-thru the steps of configuring Adeptia as an EDI Gateway.

A. Customer Users: Allow customer users to login to the Adeptia Integration Suite as business users and perform various activities such as

Manage and modify Transactions (based on user permissions)

Manage and modify Data Maps (based on user permissions)

Configure outbound data feed rules for a trading partner

View transaction history

Edit and Resubmit corrected data via workflow tasks

View Reports

B. Developer Users: Allow ACME Software developers to login to the Adeptia Integration Suite to build and manage data feeds to different carriers (trading partners) on behalf of its customers. In this component, ACME Software can

Design orchestrations for various trading partners and also reuse existing process and mapping templates

Implement maps for X12 834 and non-EDI formats

Manage services such as maps, triggers and reports

Adeptia Integration Suite is a single installer package that can be installed in the cloud or on-premise (see proposed AWS deployment in the above section). The solution configured in AIS allows ACME Software to define the process of creating an output HIPAA 834 file consists of following parts:

Database extraction rules per partner

Implement mappings or reuse of an existing HIPAA 834 mapping template

Create a process that would generate an output file based on the data extraction rules and the mapping

Specify the target location of the trading partner

Adeptia Integration Suite also allows developers to configure outbound relationships for sending the output file to a trading partner and to allow customers to access, view and modify transactions as per user permissions controlled by ACME Software.

Deployment of Adeptia application

Deployment Type: Dedicated AWS environment for ACME Software.

Adeptia would configure and install all the components needed for the installation.

Solution

We will focus on configuring the services needed for creating outbound EDI files. Adeptia Integration Suite is a web-based developer studio that is based on SOA framework. Developers configure services and reuse services as part of developing process flows. Services include database extraction rules, mappings, source/targets, APIs, and process flows that bind all the services together to produce output files.

Adeptia is a multi-tenant application where ACME Software can create a Group per Customer and these are siloed tenants that only see their transactions and trading partner setups.

Services in Integration Suite

Let’s first address the data extraction rules needed to fetch data from MS SQL database for a trading partner. In this section we will discuss how to configure the pointer to the Source database and selecting the tables. We call this “Database Schema Service” which allows users to specify the Tables. We have decoupled the schema from the “select” query logic. This allows us to use the same Database Schema Service and then apply the “select” logic independently based on the trading partner or customer.

a. Select queries to be applied on the “Database Schema Service” in order to get the specific data for the trading partner

b. Parameterized queries based on Trading Partner ID and other parameters can be used in the query logic so that the data extraction is “templatized” and dynamically produces source data per trading partner.

Data Extraction services are managed through a central repository. Users can apply version control on any service and also modify an existing service.

(Image: Adeptia Database Schema Service manage page)

(Image: Selection of Database Tables for extract data in order to generate HIPAA 834 files)

Database Source queries

Database Schema defines the endpoint and the tables needed to fetch data per trading partner. In order to provide a specific trading partner query, user creates a separate service “Database Source” and provides the specific logic of extracting the data from the schema that is defined above. Thus you can reuse a schema and apply different extraction logic (in queries) without having to re-define the schema each time.

(Image: Source database queries that can be parameterized and runs on the schema defined in the previous step)

Mapping Service

Mapping can be based out of a template map that is reused for majority of the trading partners or it is modified with unique data translation rules specific to a trading partner. In Adeptia, user configures a mappings to generate HIPAA or EDI X12 834 by using a graphical data mapper interface.

Adeptia bundles the X12 data dictionary for 834 Benefit Enrollments. This allows the developer to create a map between the source data and the output X12 834 file as shown in the image below.

Mapping service provides capabilities:

Supports Drag and Drop mapping

Supports graphical functions for non-technical users

Web UI interface

Syntax and business rules validation

Ability to show errors during validation

Supports testing, debugging and run tests with sample data

Preview transformation results inside a map

Ability to work with large files > 1MB efficiently

Supports multiple sources and targets in single map

Ability to run Java inside a map

Ability to run SQL and stored procedures inside a map

Ability to make database calls inside a map

Encoding support for Unicode, EDIX12\EDIFACT, UTF-8/16 or other

Supports many data formats such as XML, Database, Cloud Apps, ERP, CRM, CSV, Excel or other

Supports conditional and rules based mapping

Interface auto-generates a Mapping Document in PDF

Ability to write custom XSL

Supports Axis functions

Supports value maps for cross-reference lookups

Supports versioning with check-in and check-out

(Image: Adeptia Data Mapping for HIPAA 834 Benefits Enrollments)

Target Service

Target Service represents the location of the output file that will be placed in a destination as per the trading partner location. This location can be SFTP, FTP, Email or other protocols.

We recommend using standard file naming conventions for the file that contains the Partner ID and any additional parameters such as date/time stamp.

(Image: Trading Partner target SFTP location)

(Image: Conceptual view of the Services configured to create the HIPAA 834 process)

Setting up Trading Partners

In Adeptia, ACME Software developer can setup Trading Partners under each Tenant group and define the outbound relationships for each trading partner. Outbound Relationships consist of the services configured in the previous steps. Each Outbound Relationship consists of:

Source Database Event that would extract the data for a trading partner based on the schema and the extraction logic defined in the Schema and Source services. This can also be a scheduled event such as batch job.

Mapping service that takes the data from the database and maps to the X12 834 or other non-EDI standards

Target location where the file needs to be sent

Adeptia automatically sends 997 or 999 to the trading partners for inbound transactions

Users can also configure an outbound batch job that aggregates all the individual EDI messages into a single file prior to transmitting it to the trading partner

Developers can setup multiple outbound relationships for each Trading Partner. Since the application is multi-tenant, customers logging into Adeptia would only see their trading partners, B2B Dashboard and B2B Reports.

ACME Software can monitor the transactions globally to view and track all the transactions and also enable archiving to see historical data transfers.

Adeptia can also push data via APIs to the trading partners. Adeptia provides full publish/subscribe model for customers to pull or push payloads to carrier web services.

Below are the screenshots of the Trading Partner Management portal in Adeptia Integration Suite and a sample Outbound Relationship.

Tracking & Monitoring Dashboards

Customers can login and can view the dashboard, view or edit data via workflow tasks that can be enabled for business users and AIS also allow them to modify maps. ACME Software controls the customer user experience.

Here are some screenshots of how the customer user can view B2B dashboard and runtime transactions.

In Adeptia, users can go to the Trading Partner Management portal and create multiple trading partners and configure both inbound and outbound transactions. The Trading Partner Management portal is a centralized repository that shows the number of configured trading partners and their inbound/outbound relationships (as shown below).

Adeptia provides a rich dashboard capability that shows the transactions based on volume, trading partners and message types. Users can also create custom reports in PDF and Excel. In addition to the reports, users can search B2B logs based on key fields such as Plan Number, Policy Number, Partner Number, Enrollment ID, Insured Name, and or any other custom fields.

Summary

Adeptia Integration Suite provides a full EDI Gateway capability along with a robust API publish/subscribe framework. For more information, please contact sales@adeptia.com